Frisbie Memorial Hospital Marsh Brook Rehabilitation Service Wentworth-Douglass Hospital Durham: Rehab and Sports Therapy Center

Rehab 3 : One High S tandard , Thre e Loca l Par tne rs Fo r more in f ormat ion go to www.r ehab -3.com

Latarjet Procedure Weeks One To Three Weeks Three To Six

Initial Evaluation Evaluate

Posture and position of the shoulder girdle

Passive range of motion

Inspect incision for integrity and infection

Assess RTW and sport expectations

Passive range of motion

Effusion

Inspect incision for integrity and infection

Patient Education Patient Education

Support Physician prescribed meds

Discuss frequency and duration of treatment

(2x/wk for 12 to 16 weeks is anticipated)

Discuss precautions and sling use (No AROM,

sling x 4 weeks)

Wean from sling at week 4

Patients should continue to avoid AROM and lifting

of the arm until strength allows for proper mechanics

Avoid Anterior directed forces (typically combined

ABD/ER)

Educate in avoidance of activity that place stress on

shoulder (reaching in back seat of car, throwing,

sawing, raking, vacuuming, pull starts)

Therapeutic Exercise Therapeutic Exercise

Active cervical ROM, shoulder shrugs, scapular

retraction, wrist/elbow AROM and gripping are

all permitted as tolerated

May perform pendulums or “cradle the baby”,

cane assisted IR/ER in open packed position, and

table slides.

Initiate AROM without resistance or compensation

week 4 (consider Prone, side-lying, and supine table

exercises that limit stress on the biceps,

coracobrachialis, and subscapularis)

Continue self ROM activity (pendulums, table slides,

cane exs)

Initiate sub maximal isometrics

Manual Techniques Manual Techniques

No GH mobilization (underlying issue is lack of

stability)

PROM within tolerance (ABD in plane of

scapula, IR/ER in open packed position)

ER return is intended to be gradual

May perform mobilization of incision as

appropriate

No GH mobilization (underlying issue is lack of

stability)

PROM within tolerance (ABD in plane of scapula,

IR/ER in open packed position)

ER return is intended to be gradual

Initiate gentle rhythmic stabilization

Continue mobilization of incision as needed

Modalities Modalities

Any modalities as indicated for reduction of

symptoms and effusion

Any modalities as indicated for reduction of

symptoms and effusion

Goals Goals

Protect the repair

Control pain

Restore passive range of motion

Reduce inflammation

Independence with post operative precautions

Protect the repair

Control pain

Restore passive range of motion

Initiate controlled AROM

Frisbie Memorial Hospital Marsh Brook Rehabilitation Service Wentworth-Douglass Hospital Durham: Rehab and Sports Therapy Center

Rehab 3 : One High S tandard , Thre e Loca l Par tne rs Fo r more in f ormat ion go to www.r ehab -3.com

Weeks Six To Ten Weeks Ten To Sixteen

Evaluate Evaluate

Passive ROM and Active range of motion

Compensatory patterns (early scapular migration,

winging, substitution)

AROM

Compensatory patterns (early scapular migration,

winging, substitution)

Patient Education Patient Education

Educate regarding correction of abnormal

movement patterns and posture

Avoid Anterior directed forces (typically

combined ABD/ER)

Educate in avoidance of activity that place stress

on shoulder (reaching in back seat of car,

throwing, sawing, raking, vacuuming, pull starts)

Continue education regarding correction of abnormal

movement patterns and posture

Avoid Anterior directed forces (typically combined

ABD/ER)

Educate in avoidance of activity that place stress on

shoulder (reaching in back seat of car, throwing,

sawing, raking, vacuuming, pull starts)

Therapeutic Exercise Therapeutic Exercise

Initiate UBE

Pain free isotonic exercise for periscapular and

rotator cuff musculature

Progress self ROM exercises (Wall climbs,

pulleys, and gentle IR/ER self stretching)

Add closed chain proprioceptive exercises

Incorporate trunk stabilization where able (Planking,

quadruped activity, partial wall or plinth push-ups

avoiding wide hand positions)

Continue isotonic exercise for periscapular and

rotator cuff musculature, progressing to shoulder

height and above when indicated

Manual Techniques Manual Techniques

Gentle GH mobilization as indicated

Rhythmic stabilization

PNF

Gentle GH mobilization as indicated

Rhythmic stabilization

PNF

Modalities Modalities

Any modalities as indicated Any modalities as indicated

Goals Goals

Full passive range of motion (Mild ER limitation

is acceptable)

No pain with ADL’s

Normal incision tissue mobility.

4+/ 5 strength throughout

Full AROM without compensatory movement is

anticipated by week 12

Frisbie Memorial Hospital Marsh Brook Rehabilitation Service Wentworth-Douglass Hospital Durham: Rehab and Sports Therapy Center

Rehab 3 : One High S tandard , Thre e Loca l Par tne rs Fo r more in f ormat ion go to www.r ehab -3.com

Weeks Sixteen To Discharge Precautions And Concerns

Evaluate The intent of a Latarjet procedure is to restore anterior

stability to the glenohumeral joint. This procedure is often

warranted in cases where there is loss of glenoid bone due to

trauma, recurrent dislocation, or congenital factors. In cases

where there is significant glenoid loss, Bankart and other

capsular procedures become ineffective.

Latarjet involves osteotomizing the distal aspect of the

coracoid and attaching it with screws to the anterior/inferior

aspect of the glenoid. In order to perform this procedure, the

pectoralis minor and coracoacromial ligament attachments

are typically divided, and the subscapularis muscle will

typically be split along its length. Most importantly, the

biceps and coracobrachialis tendons retain their original

attachment on the coracoid which has been moved to the

anterior/inferior aspect of the glenoid. This relationship

allows the biceps, and coracobrachialis to function as the

inferior glenohumeral ligament would have originally. The

“sling” effect of the (IGHL) is restored, giving anterior

stability when the arm is abducted and externally rotated.

Early post-operative therapy must protect the

subscapularis, and the bony union of the coracoid to the

glenoid. Since the biceps and the coracobrachialis remain

attached to the new bony union, stretching and activation of

these groups must be controlled in early therapy. During the

strengthening phase, biceps and coracobrachialis

strengthening should be addressed specifically. Avoid

aggressive shoulder extension and combined extension with

external rotation in early therapy. Passive external rotation

should be performed in the open packed position, and we

should strive for gradual return of this motion. A portion of

this population may be left with slightly less external rotation.

Bear in mind, most of these patients had excessive external

rotation over a prolonged timeframe, and “normal” will often

feel tight to them.

Any deficits that may limit return to work or

sport goals

HEP compliance

Patient Education

Encourage participation in the CFA

Throwing and overhead athletics are not to be

completed until 4 months post-op and only with

physician approval

Consider long term avoidance of wide grip bench

press, military press and lat pull downs behind

the head

Therapeutic Exercise

Continue isotonic exercise for periscapular and

rotator cuff musculature, progressing to shoulder

height and above

Progress closed chain activities

Continue with self stretches as needed

Establish independent HEP to include

strengthening of periscapular and rotator cuff

musculature, closed chain activity, self stretches,

and trunk stabilization

Manual Techniques

Any techniques as indicated

Modalities

Any modalities as indicated

Goals

Normal strength

Return to work or sport

Independence with HEP